Elected Boards No Way to Run a Hospital

I asked the Joint Commission whether anything in the Grand Jury's two reports might indicate a violation of commission standards and prompt an accreditation survey or investigation.

Spokeswoman Elizabeth Zhani produced the agency's Jan. 1, 2009 leadership standard, which prohibits "disruptive and inappropriate behavior" that "undermines a culture of safety." Zhani said late Wednesday that the commission has now gotten involved. "We received a complaint related to the hospital's leadership standards and are working with the organization at the time."

Hospitals must develop and implement policies and procedures that address "zero tolerance for intimidating and/or disruptive behaviors, especially the most egregious instances of disruptive behavior such as assault and other criminal acts," And that applies to hospital leaders, including board members.

Does the board culture impede quality of care? Does it mean the hospital is constrained to provide less than it could? I'd say certainly, at some level, that has to be the case.

Board member and former chairman Larry Schallock acknowledges that this behavior has hurt the hospital's business profile. Recently, the hospital took a pounding when a 64-physician practice jumped ship to affiliate with Scripps Health hospitals, even though it meant a 20-mile + drive for doctors and their patients, he says.

Scripps and Palomar Pomerado Health, another district hospital 22 miles away, "are all looking for additional patients, and it's extremely competitive. It's real hard in this competitive market to be free-standing and survive," Schallock says.

State health officials imposed two immediate jeopardy monetary penalties on Tri-City hospital for endangering patients in 2009 and 2010. And last year, the state levied $130,000 in fines against Tri-City, the greatest amount of any hospital in the state, for delayed reporting of several adverse events. That's $100 per day for every day after five the event goes unreported.

The board's own CEO, Larry Anderson, too, has been at the center of board disputes; he was fired but then re-instated in the same week by the fractious board last year. Tri-City is now making money, and has a decent census.

Kevin T Kavanagh, MD (4/6/2011 at 12:26 PM)
The primary fiduciary responsibilty of a non-profit hospital board is NOT to the facility but to charitable purponses and the public. According to Lois Lerner, Director of the IRS Exempt Organization Division, for hospitals: "To qualify for tax-exemption, they must show that they provide benefit to a class of people, broad enough to benefit the community, and they must be operated to serve a public rather than a private interest." Source: Statement by Lois Lerner, Director of the IRS Exempt Organizations Division, on the IRS Report on Nonprofit Hospitals, at a Press Briefing, Feb. 12, 2009 http://www.irs.gov/pub/irs-tege/lernerstatement_hospitalproject_021209.pdf

Linda O (3/31/2011 at 4:15 PM)
Unless the courts step in, there will be no process for self-governance and self-correction. It's a shame to place the patients and employees at risk.

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